Heath and Aging

Menopause: Time for a Change

Signs of the Menopausal Transition

Many things can happen in a woman's body because of the changes in hormone patterns (see chart, Changes in Hormone Level Patterns, in the Introduction) that begin during the menopausal transition. Some women are bothered by only a few symptoms during perimenopause. Others are very uncomfortable, while the rest hardly feel any different. Scientists are trying to understand how the hormone changes during the menopausal transition may affect a woman's periods and menopausal symptoms.

Menstrual cycle changes. The first thing many women notice is a change in their periods. They might start coming farther apart or closer together. They might last longer or end sooner. The flow could be heavier or lighter.

Hot flashes and night sweats. Many women also start to be bothered by hot flashes or flushes and/or night sweats. The medical term is vasomotor symptoms. During a hot flash, your face and upper body begin to feel hot. Your skin gets flushed or red because blood vessels close to the surface are expanding. You might start sweating a lot, sometimes followed by cold shivering. Some hot flashes leave you with only a slight feeling of warmth or a light blush. Others may drench your clothes. Night sweats are hot flashes with sweating that happen during your sleep. They can be strong enough to wake you up at night.

Hot flashes can happen several times an hour, a few times a day, or just once or twice a week. They usually occur for just a few years and then stop, but about one woman in every ten women might have hot flashes into her sixties and seventies.

Some studies suggest that as many as three-fourths of white women have hot flashes and/or night sweats. A different study found that African-American women are more likely to report having hot flashes and night sweats than are Hispanic or white women. Japanese and Chinese women were the least likely to report this symptom.

Your skin and other tissues. As you age, your skin becomes drier. You might also start to lose fatty tissue and a protein material known as collagen under your skin and also in the areas near your vagina and urinary tract. These losses can make your skin thinner and less elastic. If your vaginal tissues are affected, these changes can make them drier and more likely to tear and become infected. Sexual intercourse may become painful.

Sleep and fatigue. Many women report having problems sleeping and feeling tired, especially in the years just before menopause and during postmenopause. But, it is difficult to know if sleep changes are a part of growing older, the result of hormone changes, or both.

Sometimes, it is night sweats that wake you in the middle of the night, or it might be that you have to go to the bathroom. Either way, once awake, you can then have trouble getting back to sleep. Perhaps you can't fall asleep in the first place, or you find yourself waking too early in the morning. When this happens over and over, you will become very tired. And feeling tired can affect everything you do during the day.

OTHER CHANGES

Scientists are working to understand how hormonal changes lead to menstrual cycle irregularities, hot flashes, night sweats, and vaginal changes. They are also trying to learn more about other changes around the menopausal transition that you may experience. Some may be the result of changes in the amounts of hormones made by your body as you go through menopause; some may be related to growing older.

Sexuality. You might notice changes in your interest in having sex (called libido) or in your ability to become sexually aroused. After menopause, some women say that freedom from concerns about pregnancy lets them feel more open to sex and more relaxed in general. Other women report losing interest in sex. If such changes bother you, talk to a doctor to make sure there is no other cause. For example, medicines, such as those prescribed to treat high blood pressure, depression, and cholesterol problems, might play a role.

Mood. There is some evidence that stress, a history of depression, and poor general health are more likely to contribute to mood changes, anxiety, and irritability during mid-life than do hormonal fluctuations. So, while women at mid-life are sometimes portrayed as having extreme mood swings, this may not be a true picture. The specific connection of mood to the hormone changes of menopause is not clear.

Physical changes. Mid-life is a time when you may see changes in your body, especially in its shape and makeup. Your joints or muscles might ache or feel stiff. Your waist might be getting thicker, and you could be gaining weight. Shifts in your body makeup such as the loss of muscle and increases in fatty tissue also take place. Muscle helps us burn a lot of calories, so losing muscle mass over time can make it harder to burn off calories and easier to gain weight.

Memory. Often, people start worrying about their memory as they get into their forties and fifties. Sometimes, it's that "tip of the tongue" problem—you can't think of a familiar word, or you can't remember the name of someone you know. Then a couple of hours later the missing word just pops into your head. Or you walk into another room for something and, once there, can't remember what you wanted. Both middle-aged men and women describe short-term memory problems. Problems like these are probably normal, but other types of memory loss might not be. For example, forgetting where you put the car keys is normal, but forgetting how to drive the car is not.

Mid-life is a time that may bring new or greater sources of stress, and this stress can also add to memory problems. Stress is how the body responds to changes (both good and bad) and challenges in order to prepare to protect itself if needed. Some experts suspect that when you have a lot going on in your life, it can be harder to remember as much as you once did. Although mild, short-lived stress actually may improve learning in some situations, the complicated sources of stress in mid-life might interfere with your learning something new in the first place. So, sometimes, it's not that you forgot things that happened recently, it's that your brain never recorded it as something to remember.